Please include $150 cash or cheque payable to Club Oxford Hockey. Game fees will be maintained at $10 .
| In consideration
of being allowed to participate in any way in the Tillsonburg Club Oxford
Hockey League games, events, related events, and activities, the undersigned
understands, appreciates, acknowledges, and agrees that:
1. The risk of injury from activities involved in these programs, events, related events, and activities is significant, including but not limited to the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
2. I knowingly and freely assume all such risk, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
4. I, for myself, and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless the Tillsonburg Club Oxford Hockey League, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (“Releasees”), with respect to any and all injury, death, or loss or damage to person or property, whether aring from the negligence of the releasees or otherwise.
I have read this release of liability and assumption of risk agreement, fully understanding its terms, and understand that I have given up substantialrights by signing it, and sign it freely and voluntarily without any inducement.
|print name : age :|
|phone : email :|
|preferred position :|
|Are you willing to play in either division (if not, please explain)|
|How many games do you expect to miss of the 18 Sundays and 9 Wednesdays of the regular season?|
|signature : date :|